Inside Venezuela’s Crumbling Mental Hospitals

The state-run psychiatric hospital here in Barquisimeto, Venezuela, has long been a forgotten place, filled with forgotten people.

But with Venezuela suffering from a severe economic crisis, this mental institution has almost no drugs to control the afflictions tormenting its patients.

At the invitation of doctors, reporters from The New York Times visited six psychiatric wards across the country. All reported shortages of medicine, even food.

The one here, El Pampero Hospital, hasn’t employed a psychiatrist in two years. It has running water for only a few hours a day, and food is scarce. Omar Mendoza, pictured above, is one of many undernourished patients. He lost half his weight this summer and is down to about 75 pounds.

The glue that keeps this hospital in order — the sedatives, tranquilizers and medications — is nearly all gone. In courtyards, women who are functional while medicated are now curled on the floor hallucinating, crying, screaming, rocking back and forth for hours.

The nursing staff debates daily: Who gets the few remaining pills? Who is the most unstable, or suffering the most? They reduce doses, doling out pills into small metal cups with the fluidity of Las Vegas casino dealers.

El Pampero also suffers from shortages of basic personal-care and cleaning supplies. There is no soap, no shampoo, no toothpaste, no toilet paper. Patients relieve themselves in the common areas and patio area, and clean themselves only with water.

Nurses fear that patients in the men’s ward are more likely to become violent when they are unmedicated. Two of the men in this photograph murdered members of their families before their schizophrenia was diagnosed. One decapitated his mother, and the other stabbed his stepfather.

We found Cleofila Carillo crying softly under a mosquito net. The morning before, her unmedicated bunkmate had leapt on top of her, beaten her, bitten off her nose and eaten it. Doctors said she needed full reconstructive surgery, but because of the shortages, they did not have the medical supplies to perform it. All they could do was apply a bandage.

Without sedatives, nurses say, they must restrain patients or lock them in isolation cells to keep them from harming themselves. That is what happened to Raul Martínez, who was suffering a psychotic episode. A nurse tied him to a gurney.

Patients eat three times a day, but there is never enough food from the government. Members of the hospital staff solicit donations during their time off. Medical records show that over half of the patients in the men’s ward are underweight.

Clothes are also in short supply at the hospital. Many patients in the women’s ward wear only T-shirts, and few have shoes. The clothing they do have is ill fitting and threadbare. Nurses fashion belts out of surgical gloves and pieces of rope to keep patients’ pants from sliding off their slight frames.

Down the hall, Ms. Carillo’s attacker had been isolated and locked inside a small solitary confinement cell. She yelled at nurses when they asked why she had bitten off and swallowed her roommate’s nose. “It wasn’t me, I did not do it,” she repeated, claiming that she did not know what they were talking about.

When Yusmar Torres had no medication to control her mood disorder and depression, she constructed a noose out of a bedsheet and threatened to commit suicide. The staff stripped her of her clothes for safety and put her in a solitary confinement cell, where she was left for days.

There are few light moments in El Pampero, but every Friday morning, therapists put on salsa music and hold a dance for the 10 percent of patients who are stable enough to participate. Before the medicine shortages, the recreation center held weekly sewing, cooking and sculpture classes, even a farming program. One therapist said: “When patients have their medicines, they can do really complex crafts. Now they just do simple tasks.”

The head nurse, Evila García, fed a blind patient as a stray cat roamed the women’s ward dining hall. Several stray dogs and cats live in the hospital, and the dogs often sleep with patients in their beds. Nurses worry about parasites because the animals have not had their shots and have not been dewormed, but some patients find comfort in them.

Josefina Zapata, a patient suffering from psychosis and epilepsy, was in solitary confinement. She was not violent, but the hospital staff did not have the anticonvulsants she needed. The staff regularly kept her locked in this cell, on a mattress on the floor, so that when she started convulsing, she was less likely to hurt herself.

The vast majority of patients living at El Pampero have been abandoned by their families and rely completely on the state to meet their basic needs. “May God have mercy on us,” the head nurse said.